EP1360972B1 - Einführvorrichtung zum Zugriff auf den Koronarsinus des Herzens - Google Patents

Einführvorrichtung zum Zugriff auf den Koronarsinus des Herzens Download PDF

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Publication number
EP1360972B1
EP1360972B1 EP03008584A EP03008584A EP1360972B1 EP 1360972 B1 EP1360972 B1 EP 1360972B1 EP 03008584 A EP03008584 A EP 03008584A EP 03008584 A EP03008584 A EP 03008584A EP 1360972 B1 EP1360972 B1 EP 1360972B1
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EP
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Prior art keywords
coronary sinus
distal
inches
introducer
guiding introducer
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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EP03008584A
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English (en)
French (fr)
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EP1360972B8 (de
EP1360972A1 (de
Inventor
Seth J. Worley
Paul Kurth
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Pressure Products Medical Supplies Inc
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Pressure Products Medical Supplies Inc
New Chester Insurance Co Ltd
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Publication of EP1360972B8 publication Critical patent/EP1360972B8/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/12—Blood circulatory system
    • A61M2210/125—Heart

Definitions

  • This invention relates to sheaths and introducers, which are utilized in a human heart, which has been altered by heart disease. More particularly, this invention relates to a precurved, guiding introducer for introducing specialized medical devices into the coronary sinus of a heart with cardiomyopathy and a process for introduction of those devices into the coronary sinus utilizing the precurved, guiding introducer.
  • pacemaker leads such as pacemaker leads, defibrillation leads or leads used for cardioversion, or specialized catheters are frequently placed at specific locations within the heart to perform specialized cardiac procedures.
  • Many of these medical devices, such as pacemaker leads are very pliant and flexible. This flexibility is necessary to prevent damage, particularly to the patient's vasculature, during the period of time those products are present in the patient.
  • stiffening certain medical devices is to introduce a stylet into the lumen of the medical device.
  • the typical procedure for introducing these devices into the heart requires passage through the patient's vasculature.
  • One early approach to introduction of devices into the vasculature was to surgically cut an opening into the patient's vasculature.
  • percutaneous methods have been developed to create openings in the vasculature. Once an opening is created, frequently by use of a hollow needle, a dilator is usually inserted into the vasculature, which gradually increases the size of the opening.
  • the dilator has a tapered end, which spreads apart the tissue at the puncture sight as it is advanced through the vasculature. Often the dilator will contain a lumen through which other medical devices may also be inserted into the vasculature.
  • a guidewire is first introduced through the vasculature into the appropriate chamber of the heart. With the guidewire in place, a catheter/introducer or dilator/introducercombination is then passed over the guidewire and directed into the patient's body. The catheter or dilator is then removed from the introducer. The introducer then provides a platform from which the lead may be introduced into the heart, frequently with a stylet placed within the lumen of the lead to assist in stiffening the structure of the lead and also to permit precise placement of the device within the heart.
  • the maximum diameter of the pacemaker lead that can be inserted is no larger than the lumen of the introducer.
  • This limitation created a significant problem because of the nature of pacemaker leads.
  • the pacemaker lead's proximal end contained an electrical connector for connection to the pulse generator.
  • the invention contemplates that these introducers or sheaths are splittable, sliceable or tearable to assist in the insertion of these electrode leads.
  • the size of the lumen of the splittable, sliceable or tearable introducer can remain relatively small as it need be no larger than is necessary for passage of the distal tip of the medical device through the lumen of the introducer.
  • the prior art uses a splittable hemostatic valve, such as shown in U.S. Patents 5,125,904 and 5,312,355 , that is utilized in combination with a splittable sheath for introduction of a pacemaker electrode into a patient.
  • the coronary sinus is the largest cardiac vein in the heart and serves as a venous conduit from smaller veins within the myocardium to the right atrium.
  • a tissue fold or primitive valve covers the coronary sinus ostium to prevent blood from backflowing into the coronary sinus as it is being pumped out of the right atrium.
  • Located within the right atrium, generally, above the coronary sinus is an oval depression called the fossa ovalis.
  • the Eustachian ridge Between the inferior vena cava and the coronary sinus ostium is the Eustachian ridge. The location of each of these elements may vary from patient to patient.
  • the coronary sinus is often used for electrophysiological procedures in the heart, including both diagnostic and treatment procedures.
  • the coronary sinus can also be used as a location for pacing both the left and right sides of the heart. Gaining access to the ostium of the coronary sinus is a very difficult procedure, especially because of the large number of similar anatomical structures located near the coronary sinus within the right atrium. It is especially difficult because these anatomical structures do not show up on a fluoroscope.
  • an aspect of this invention to disclose an optimally shaped device, which assists in the efficient placement of medical devices particularly small, flexible medical devices, such as electrode leads, into the coronary sinus, even by physicians without a high level of experience in using the device.
  • a medical device such as a flexible lead for use with a pacemaker, defibrillator or for cardioversion
  • Another aspect of this invention is to disclose a fixed shape introducer to be used for the introduction of medical devices into the coronary sinus by ordinarily skilled physicians without specific experience with the introducer.
  • Another aspect of the invention is to disclose a fixed shaped introducer which can be used in a process for the introduction of medical devices into the coronary sinus without using a guidewire by ordinarily skilled physicians without specific experience with the introducer.
  • Another aspect of the invention is to disclose a process for the introduction of flexible medical devices into the coronary sinus of the human heart using a precurved guiding introducer by ordinarily skilled physicians without specific experience with the introducer.
  • the invention is used in diseased hearts, namely enlarged hearts having cardiomyopathy.
  • the invention is defined as a precurved coronary sinus guiding introducer comprising a flexible elongated member with a proximal and distal end.
  • the elongated member comprises a generally straight, proximal portion and a precurved distal portion.
  • the proximal portion and distal portion are formed to lie is a common plane.
  • the curved subportion and the straight subportion of the precurved distal portion may be inclined with respect to each other out of the common plane by plus or minus 30 - 40 degrees.
  • the precurved distal portion comprises at least one curved subportion and at least one curved or straight single distal most subportion.
  • the precurved distal subportion curves through a generally circular arc away and is defined by a chord of predetermined length.
  • the precurved distal subportion has a predetermined height above the chord.
  • the curved or straight subportion is the distal section of the precurved distal portion.
  • the coronary sinus guiding introducer further comprises a lumen extending through the member from the proximal to the distal end.
  • the member is solid and is used as a dilator for use in combination with a catheter.
  • the chord has the predetermined length of approximately 6 - 18 cm (3.5 to 7 inches) and the predetermined height above the chord is approximately 6 - 10 cm (2.5 inches to 4.0 inches).
  • the chord has the predetermined length of approximately 14cm (5.5 inches) and the predetermined height above the chord is approximately 6.3cm (2.5 inches).
  • the curved or straight subportion is approximately 1.2 to 11.5 cm (0.5 to 4.5 inches) in length and preferably approximately 6.3cm (2.5 inches) in length.
  • the member has an inside diameter of 9 French.
  • the coronary sinus guiding introducer of the present invention assists an ordinarily skilled and experienced physician or cardiologist, having no special prior experience with the introducer of the invention, in the quick introduction of specialized medical devices, such as a pacemaker lead or defibrillator lead, into the coronary sinus of the human heart.
  • specialized medical devices such as a pacemaker lead or defibrillator lead
  • the coronary sinus is the largest cardiac vein and serves as a conduit for access to various locations within the heart. Depending on the depth of insertion of the medical device into the coronary sinus, both the left and right atria and the left and right ventricles of the heart can be analyzed. However, introduction of a medical device into the ostium of the coronary sinus is quite difficult as a result of the structure of the heart, the difficulty in locating the coronary sinus using conventional medical technology and the constantly changing shape of the heart while beating as well as the altered anatomy of the heart with cardiomyopathy. Because of its unique shape, the introducer of the present invention assists in rapid placement of medical devices within the coronary sinus, thereby reducing the amount of time necessary for performance of the medical procedure. (The term "introducer" is synonymous with the term "sheath.” )
  • Two approaches are commonly used for placement of a medical device within the coronary sinus, an inferior approach from below the heart, and a superior approach from above the heart.
  • the device is advanced through either the left cephalic or left subclavian vein through the superior vena cava into the right atrium until it is directed toward the coronary sinus. See FIG. 1a .
  • the device is generally advanced through the femoral vein through the inferior vena cava into the right atrium. See FIG. 1b . The tip of the device is then directed toward the ostium of the coronary sinus.
  • the superior approach is the preferred approach and is the approach for which the introducer of the present invention is optimized.
  • fluoroscopes cannot easily identify specific features in the heart, in general, and the critically important structures of the right atrium, specifically, thus making placement of medical devices into the coronary sinus extremely difficult.
  • placement of medical devices in the coronary sinus is especially difficult when the heart is beating and the location of the coronary sinus altered by cadriomyopathy.
  • the medical device to be introduced is a flexible, flaccid product such as a pacemaker lead, placement in the coronary sinus is especially difficult.
  • the introducer is designed to be used in diseased hearts having cardiomyopathy, which hearts have been enlarged because of that disease. Because of the enlargement of the hearts the anatomy is changed and shapes which have been designed for normal hearts or hearts having other diseases other than cardiomyopathy are difficult to use.
  • the claimed design is surprisingly adapted to quick and easy access to the coronary sinus in cardiomyopathic hearts.
  • the structure and shape of the guiding introducer of the present invention addresses and solves this problem and permits the precise and quick placement necessary for introduction of medical devices, such as leads, into the coronary sinus even by those physicians not having extensive prior experience with the introducer.
  • the shaped guiding introducer of this invention readily positions the medical device inserted through its lumen at the precise location necessary for the procedure as a result of its shape.
  • This specially designed guiding introducer is generally produced from a conventional elongated introducer.
  • the guiding introducer of the invention is produced utilizing a conventional introducer production procedure and is preferably formed as a single, unitary structure.
  • Fig. 2 is a plan elevational side view of introducer 10 of the invention.
  • Introducer 10 lies in a single plane, such as the plane of Fig. 2 .
  • Portion 12 is the defined as the proximal portion of introducer 10 and is a generally unbiased, flexible section of introducer 10 leading from the percutaneous introduction point into the left auxiliary subclavian vein and through the vasculature leading toward the atrium of the heart.
  • a biased portion 16 of introducer 10 forms the distal portion of introducer 10, and is either integral with or may be separately fabricated from portion 12. While still being flexible, portion 16 is biased to have a memory so that when the vasculature permits, it tends to assume a prebiased shape as seen in Fig. 2 and described in more detail below. On the other hand, the bias is not so strong that portion 16 is not easily conformed to the vasculature without risk of injury.
  • portion 16 has an arcuate bias to form a modified circular curvature so that the chord 14 across the open mouth of the hook shape is in one embodiment approximately 14cm (5.5 inches) in a sheath or introducer 10 having a total length of 45cm and a 9 French diameter.
  • the chord length 14 may vary within a range of the illustrated embodiment, namely in a range of 6 - 18 cm (3.5 to 7 inches).
  • the height of the arc of portion 16 from the chord 14 is approximately 6 cm (2.5 inches) in the illustrated embodiment, but may range from 3.8 to 10.2 cm (1.5 to 4.0 inches).
  • portion 16 is straightened or slightly straightened to at least have less curvature than the remainder of portion 16 or a very low curvature, if any.
  • Portion 20 has a length of approximately 2.5cm (1 inch), but again may vary in a range of approximately 1.2 to 11.5 cm (0.5 to 4.5 inches).
  • the guiding introducer 10 may be made of any biocompatible material suitable for use in humans which has a memory or permits distortion from and substantial return to the desired three dimensional shape, such as polyethylene or polyurethane.
  • the distal tip 22 of the guiding introducer 10 may be made of a more pliable, more compressible material, than the remaining length of the coronary sinus guiding introducer 10 to prevent damage to the vasculature and the coronary sinus when in use.
  • the distal tip 22 is made radioopaque by use of a marker 24.
  • the internal diameter of the guiding introducer 10 may vary from about 4 to about 16 French (1 French equals 1/3 of a millimeter). Such guiding introducers 10 can thus accept dilators whose outside diameter is from about 4 to about 16 French. Obviously, if larger or smaller dilators or other medical devices are used in combination with the guiding introducer, modifications in size and shape of the guiding introducer 10 can be made.
  • the precurved guiding introducer 10 of the invention may also be multi-lumened. According to conventional design principles, the structure of the introducers 10 may be modified to permit the presence of an inflatable balloon near or at its distal tip or electrodes for sensing or ablation.
  • Variations in size and shape of the guiding introducer 10 are intended to encompass pediatric uses for the guiding introducer of the present invention, although the preferred uses are in adult human hearts. It is well recognized that pediatric uses may require reductions in size of the various portions of the guiding introducer 10, in particular shortening the first portion 12, with a proportional reduction in the height, arc and length of the distal portion 16 of the guiding introducer 10, which may extend the lower limits of the specific ranges of the above parameters from those explicitly recited above. In addition, variations in size or shape are also intended to encompass specialized situations that sometimes occur in patients with enlarged or rotated hearts.
  • the structure of the guiding introducer 10 should be stiff enough to prevent substantial movement of the distal section of the guiding introducer 10 once in place within the heart and to retain its general shape.
  • the generally straight portion 12 may be made stiffer than the curved distal portion 16. This stiffer construction can be achieved by conventional construction techniques, such as increasing the thickness of the material or manufacturing a portion of the guiding introducer 10 from a material possessing characteristics of enhanced stiffness, such as by adding a metal component, a stiffener material or by fusing different materials together.
  • the second, distal portion 16 of the guiding introducer should be stiff, but flexible. This will permit the curved section of distal portion 16 to be straightened when a dilator is passed through its lumen to facilitate insertion into the patient's vasculature and for passage through the vasculature into the right atrium.
  • the distal tip portion 20 should be more pliable than the remaining portions of the guiding introducer 10 to prevent damage to the vasculature during insertion of the guiding introducer through the vasculature.
  • the stiffness of the coronary sinus guiding introducer 10 can also be enhanced by insertion of a dilator or shaped catheter within the lumen of the guiding introducer 10.
  • a "dilator” is an inner strengthening element intended to be removed to allow placement of the introducer 10.
  • the dilator acts as a stiffening means for stiffening the structure of the coronary sinus guiding introducer 10.
  • the dilator is produced from conventional dilator material and preferably contains a lumen passing therethrough for use with a guidewire.
  • the shape of the dilator conforms to the shape of the coronary sinus guiding introducer 10.
  • the shape of the dilator can be straight, such that upon introduction into the lumen of any of the precurved coronary sinus guiding introducer 10 discussed above, the overall shape of the coronary sinus guiding introducer 10 is straightened, making insertion of the combination through the vasculature easier.
  • the coronary sinus guiding introducer 10 returns to its predetermined shape as shown in Fig. 2 .
  • the shape of the present invention allows an ordinarily skilled physician to canulate the coronary sinus in less than a minute, whereas canulation times for conventionally shaped introducers typically take up to almost an hour.
  • a modified Seldinger technique is used for insertion of the coronary sinus guiding introducer 10 and any devices which will pass through the lumen of the guiding introducer 10 into the human body.
  • a guidewire is inserted and advanced through the vasculature into the chamber of the heart where the procedure will be performed.
  • the guidewire is advanced through the left cephalic or left subclavian vein through the superior vena cava and into the right atrium.
  • the guiding introducer 10 with dilator present in its lumen is then passed over the guidewire into the right atrium as shown in FIG. 1a .
  • the particular structure and curvature of the guiding introducer's distal portions 16 and 20 permits ease in locating the ostium of the coronary sinus in the superior approach.
  • the tip of the coronary sinus guiding introducer 10 is then advanced as far as is required or desired into the coronary sinus.
  • the dilator may be removed from the coronary sinus guiding introducer 10 at any point when appropriate. For example, if the dilator and the coronary sinus guiding introducer 10 both have the same shape, it may be best to introduce them in combination into the coronary sinus and only after the coronary sinus guiding introducer 10 is in place will the dilator be withdrawn.
  • the dilator if it is straight, it should be withdrawn from the precurved guiding introducer 10 prior to any attempt to place the guiding introducer 10 into the coronary sinus. If the dilator is precurved and the guiding introducer 10 is straight, the introducer 10 is advanced into the coronary sinus once the dilator has been advanced into the coronary sinus.
  • the medical device to be placed in the patient's heart is then advanced through the lumen of the guiding introducer 10 into the coronary sinus.
  • a temporary or permanent pacemaker lead may be advanced through the lumen of the guiding introducer 10 to be placed within the coronary sinus.
  • a stylet may be inserted into the lumen of the lead to provide additional stiffness for the lead and to allow easy advancement of the lead through the lumen of the coronary sinus guiding introducer 10.
  • the lead is then secured in place by conventional procedures.
  • the guiding introducer 10 is withdrawn from the body of the patient.
  • the order of removal of stylet and introducer 10 and securing the lead in place is not critical and may vary depending on the preference of the medical practitioner.
  • the proximal end of the lead is generally either attached to a connector or is directly attached to the pulse generator of the pacemaker, it is often critical that the guiding introducer 10 be splittable, sliceable or tearable to allow it to be separated into two lengthwise portions as it is removed from the patient's body. Once it is split, it can be removed from the operating theater. Alternatively, if the lead is relatively small and not connected to a pulse generator and the lumen of the guiding introducer 10 is relatively large, it will not be necessary for the introducer 10 to be splittable, sliceable or tearable.
  • the guiding introducer 10 can be used to introduce a number of different types of medical instruments into the body through its lumen including a permanent or temporary pacemaker lead, a defibrillator lead, ablation or sensing catheters or any such medical devices that will find use if placed within the coronary sinus. These other uses are well known in the industry and are within the contemplation of the present invention.
  • the guiding introducer 10 can also be used to introduce a wire guide into the coronary sinus.
  • the guiding introducer 10 is first advanced into the coronary sinus followed by the guidewire. Once the guidewire is in place, the guiding introducer 10 can be removed.
  • a lead or other types of medical devices can then be advanced over the wire guide until in place in the coronary sinus.
  • the lead for example, may have a lumen or track so that it can be advanced using the guidewire into the coronary sinus.
  • Fig. 3 illustrates another embodiment where various portions of introducer 10 lie in different planes.
  • proximal portion 12 may be defined to lie in a first plane, which can be called the basal plane in this description, although it is to be understood that proximal portion 12 is flexible and when in use will track the vasculature system's three dimensional shape.
  • proximal portion 12 when introducer 10 is laid on a flat surface, proximal portion 12 will compliantly lie on that flat surface of the basal plane.
  • Arcuate biased portion 16' will then be biased to lie in a plane making a dihedral angle of approximately 30-40° with respect to the basal plane.
  • distal-most end portion 20' will then be biased to lie in a plane making a dihedral angle of approximately 30-40° with respect to the arcuate biased portion 16'.
  • the positive or negative angulation of the plane of distal-most end portion 20' is independent of the positive or negative angulation of the plane of arcuate biased portion 16'.
  • distal-most end portion 20' may thus be approximately parallel to the three dimensional orientation of the basal plane, depending on the angulations chosen for the planes of distal-most end portion 20' and arcuate biased portion 16'.
  • the out-of-plane angulations of the portions 12, 16' and 20' of introducer 10 may be chosen in any combination desired consistent with the teachings of the present invention.
  • Fig. 4 is a plan view of an another embodiment of an introducer 10 which lies substantially in the plane of the drawing and which is adapted for use in the coronary sinus of the heart.
  • a proximal handle 26 is connected to a hub 28.
  • a flexible sidearm catheter 30 is communicated to hub 28 and is distally terminated with a hemostatic valve 32.
  • a flexible body portion 12 extends to a first distal curved portion 34, which has a radius of curvature of approximately 6,35 ⁇ 0,63 cm (2.5 ⁇ 0.25 inches). Curved portion 34 continues into a distal straight portion 36.
  • introducer 10 continues distally with a second curved portion 38, which has a radius of curvature of approximately 5 ⁇ 0,63 cm (2.0 ⁇ 0.25 inches) and which bends in the same direction of first curved portion 34 making an approximate semicircular arc comprised of portions 34, 36 and 38.
  • the chord 39 defined by the semicircular arc comprised of portions 34, 36 and 38 is approximately 13 ⁇ 0,63 cm (5.125 ⁇ 0.25 inches) when measured on a line drawn perpendicular to flexible portion 12.
  • the entire length of introducer 10 from proximal handle 26 to distal tip 22 is approximately 13.78 inches (35 cm) and its diameter is 9 French.
  • the length of portion 12 can of course be chosen arbitrarily according to design choice, the shape of the distal portion of introducer 10 being more materially important to proper placement in the coronary sinus.
  • Fig. 4 may be modified according to the invention to assume another embodiment as illustrated in the plan view of Fig. 5 , which introducer 10 also lies substantially in the plane of the drawing and which is adapted for use in the coronary sinus of the heart.
  • flexible body portion 12 leads to a single curved portion 42, which has a radius of curvature of approximately 5 ⁇ 0,63 cm (2.0 ⁇ 0.25 inches).
  • Curved portion 42 continues distally in a straight portion 44.
  • Straight portion 44 in turn continues with a second curved portion 45, which has a radius of curvature of approximately 7 ⁇ 0,63 cm (2.75 ⁇ 0.25 inches).
  • Second curved portion 45 transitions smoothly into a third curved portion 47, which has a radius of curvature of approximately 5,72 ⁇ 0,63 cm (2.25 ⁇ 0.25 inches).
  • Third curved portion 47 terminates with a straight portion 49 ending in distal tip 22.
  • the centers of curvature of each of the first, second and third curved portions 42, 45 and 47 are on the same side of introducer 10 so that the distal end forms a compound arc having a chord 51 of approximately 14 ⁇ 0,63 cm (5.46 ⁇ 0.25 inches) in length when measured on a line drawn perpendicular to flexible portion 12.
  • the longitudinal throw or length 53 of the distal most section of the compound arc measured from a line perpendicular to flexible portion 12 from the rearmost part of the compound arc to distal tip 22 is approximately 5,72 ⁇ 0,63 cm (2.25 ⁇ 0.25 inches) in length.
  • the overall length of introducer 10 is about 17.71 inches (45 cm) and its diameter is 9 French.
  • the length of portion 12 can of course be chosen arbitrarily according to design choice, the shape of the distal portion of introducer 10 being more materially important to proper placement in the coronary sinus.
  • Fig. 5 may in turn be modified according to the invention to assume yet another embodiment as illustrated in the plan view of Fig. 6 ; which introducer 10 also lies substantially in the plane of the drawing and which is adapted for use in the coronary sinus of the heart.
  • flexible body portion 12 leads to a first curved portion 46, which curved portion 46 has a radius of curvature of approximately 5 ⁇ 0,63 cm (2.0 ⁇ 0.25 inches).
  • Curved portion 46 continues smoothly into a second curved portion 55, which has a radius of curvature of approximately 17,8 ⁇ 0,63 cm (7.0 ⁇ 0.25 inches).
  • Second curved portion 55 continues smoothly into a third curved portion 57, which has a radius of curvature of approximately 3,18 ⁇ 0,63 cm (1.25 ⁇ 0.25 inches).
  • third curved portion 57 continues distally in a straight portion 48 to distal tip 22.
  • the centers of curvature of the curved portions 46, 55 and 57 all lie on the same side of introducer 10 so that a compound arc is formed defining a chord 59 having a length of approximately 16,5 ⁇ 0,63 cm (6.5 ⁇ 0.25 inches) when measured on a line drawn perpendicular to flexible portion 12.
  • the overall length of introducer 10 is about 19.29 inches (49 cm) and its diameter is 9 French.
  • the length of portion 12 can of course be chosen arbitrarily according to design choice, the shape of the distal portion of introducer 10 being more materially important to proper placement in the coronary sinus.
  • Fig. 6 may in turn be modified according to the invention to assume yet another embodiment as illustrated in the plan view of Fig. 7 , which introducer 10 also lies substantially in the plane of the drawing and which is adapted for use in the coronary sinus of the heart.
  • flexible body portion 12 leads to a first curved portion 60, which has a radius of curvature of approximately 7,3 ⁇ 0,63 cm (2.875 ⁇ 0.25 inches).
  • Curved portion 60 continues smoothly into a straight portion 62, which smoothly transitions to a second curved portion 64, which has a radius of curvature of approximately 3,18 ⁇ 0,63 cm (1.25 ⁇ 0.25 inches).
  • Second curved portion 64 continues smoothly into a straight portion 66 to distal tip 22.
  • the centers of curvature of the curved portions 60 and 64 all lie on the same side of introducer 10 so that a compound arc is formed defining a chord 68 having a length of approximately 13,5 ⁇ 0,63 cm (5.3 ⁇ 0.25 inches) when measured on a line drawn perpendicular to flexible portion 12.
  • the overall length of introducer 10 is about 17.17 inches (45 cm) and its diameter is 9 French.
  • the length of portion 12 can of course be chosen arbitrarily according to design choice, the shape of the distal portion of introducer 10 being more materially important to proper placement in the coronary sinus.
  • the curves shown in Figs. 4 - 7 are each characterized by a proximal and distal curved portion forming part of the compound arc at the distal portion of introducer 10.
  • the embodiments of Figs. 5 - 7 are adapted for use in the coronary sinus of hearts of different topologies, e.g. child and adult.
  • the embodiments of Figs. 5 and 6 have the same radius of curvature for the proximal and distal curved portions, but differ in the nature of the curvatures of the interlying portions between the proximal and distal curved portions.
  • the embodiments of Figs. 5 and 6 can thus be thought of as having a similar shape, but in two different sizes, the size of Fig. 6 being the larger of the two.
  • the embodiments of Figs. 5 and 6 would thus be adapted for use in hearts of similar topology, but different sizes.
  • Guide catheter placement in the coronary sinus is essential for delivery of a biventricular pacing lead.
  • the available delivery system shapes frequently cannot locate the coronary sinus without the use of an electrophysiology catheter. Therefore, designing a guide catheter that cannulates the coronary sinus easily, safely, and utilizing minimal contrast is imperative.
  • a standard multipurpose PTCA guiding catheter was hand-modified according to the invention to assume the shape of Fig. 2 .
  • the amount of contrast required was less than 14.5 cc.
  • the guide shape in case #30 was enlarged by 30% after 2 min 23 seconds, enabling cannulation to occur within 35 seconds. 31 cases were performed without complications and without the use of an electrophysiology catheter.
  • the new shape developed in the invention provides safe, rapid access to the coronary sinus with minimal contrast usage and without the need for an electrophysiology catheter.
  • features of this guiding introducer 10 include its unique shape, but may also incorporate a splittable, sliceable or tearable structure, increased stiffness to minimize compression when positioned in tight bends, radioopaque tip markers, balloons and vents according to conventional design principles.
  • the entire length of the guiding introducer 10 is splittable, sliceable or tear-away to permit the guiding introducer 10 to be divided into two separate halves as it is removed from the patient's body. Any structure which will permit the division of the guiding introducer 10 into two separate longitudinal halves is within the scope of the invention.
  • the guiding introducer 10 contains a pair of mechanically formed, longitudinally extending zones of reduced thickness defined by internally scored, longitudinally shallow grooves or indentations running throughout the length of the introducer 10. These mechanically formed, reduced thickness zones permit the guiding introducer 10 to be "split" or “torn away” following use.
  • the guiding introducer 10 is sufficiently large and the size of the diameter of the medical device passing through the guiding introducer 10 is not larger than the lumen of the guiding introducer 10, it is not necessary that the guiding introducer 10 be splittable, sliceable or tearable.

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Claims (15)

  1. Vorgekrümmte Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung zur Verwendung in einem Herzen, umfassend:
    ein flexibles längliches Element (10) mit einem proximalen Ende und einem distalen Ende (22), wobei das längliche Element (10) einen im Allgemeinen geraden, proximalen Bereich (12) und einen vorgekrümmten distalen Bereich (16) umfasst, wobei der proximale Bereich (12) und der distale Bereich (16) so ausgebildet sind, dass sie in einer gemeinsamen Ebene liegen,
    wobei der vorgekrümmte distale Bereich (16) zumindest einen gekrümmten Unterbereich und einen gekrümmten oder geraden einzelnen, am weitesten distal liegenden, Unterbereich (20) umfasst, gekennzeichnet durch eine Spitze des einzelnen, am weitesten distal liegenden Unterbereichs, die im allgemeinen in eine Richtung parallel zum proximalen Bereich (12) ausgerichtet ist, wobei der vorgekrümmte distale Bereich (16) über einen im Allgemein kreisförmigen Bogen gekrümmt verläuft, der durch eine Kreissehne (14) mit einer vorbestimmten Länge im Bereich von 8,9 cm (3,5 Zoll) bis 17,8 cm (7 Zoll) definiert ist, und der vorgekrümmte distale Bereich eine vorbestimmte Höhe (18) von der Kreissehne (14) im Bereich von 6,35 cm (2,5 Zoll) bis 10,2 cm (4 Zoll) aufweist.
  2. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei der einzelne, am weitesten distal liegende Unterbereich (20) durch eine geringere Krümmung als der eine gekrümmte Unterbereich gekennzeichnet ist.
  3. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1, ferner umfassend ein Lumen, das sich durch das Element (10) vom proximalen zum distalen Ende (22) erstreckt.
  4. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei das Element (10) fest ist und als ein Dilator zur Verwendung in Kombination mit einem Katheter verwendet wird.
  5. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei die Kreissehne (14) die vorbestimmte Länge von ungefähr 14 cm (5,5 Zoll) aufweist.
  6. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei die vorbestimmte Höhe über der Kreissehne (14) ungefähr 6,35 cm (2,5 Zoll) beträgt.
  7. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei der am weitesten distal liegende Unterbereich (20) eine Länge von ungefähr 1,87 cm (0,5) bis 11,4 cm (4,5 Zoll) aufweist.
  8. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 7,
    wobei der am weitesten distal liegende Unterbereich (20) eine Länge von ungefähr 6,35 cm (2,5 Zoll) aufweist.
  9. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei das Element (10) einen Innendurchmesser von 9 French aufweist.
  10. Vorgekrümmte Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1 zur Verwendung in einem Herzen,
    wobei der vorgekrümmte distale Bereich (16) zumindest einen gekrümmten Unterbereich, der in einer ersten Ebene liegt, und einen einzelnen, am weitesten distal liegenden Unterbereich (20) und einen proximalen Bereich (12), die in oder parallel zu einer zweiten Ebene liegen, umfasst, wobei der vorgekrümmte distale Bereich (16) über einen im Allgemein kreisförmigen Bogen gekrümmt verläuft, der durch eine Kreissehne (14) mit einer vorbestimmten Länge im Bereich von 8,9 cm (3,5 Zoll) bis 17,8 cm (7 Zoll) definiert ist, und der vorgekrümmte distale Bereich eine vorbestimmte Höhe (18) über der Kreissehne (14) von ungefähr 6,35 cm (2,5 Zoll) bis 10,2 cm (4 Zoll) aufweist, wobei die erste und die zweite Ebene in Bezug aufeinander um ungefähr 30° bis 40° geneigt sind.
  11. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 10,
    wobei die Kreissehne (14) die vorbestimmte Länge von ungefähr 14 cm (5,5 Zoll) aufweist.
  12. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 10,
    wobei die vorbestimmte Höhe über der Kreissehne (14) ungefähr 6,35 cm (2,5 Zoll) beträgt.
  13. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei der vorgekrümmte distale Unterbereich (16) aus zwei gekrümmten Bereichen und zwei geraden Bereichen in wechselnder Abfolge mit einem distalen der zwei geraden Bereiche, die zu dem distalen Ende führen, besteht.
  14. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 19,
    wobei die zwei gekrümmten Bereiche einen proximalen gekrümmten Bereich mit einem Krümmungsradius von ungefähr 5,1 cm bis 7,24 cm ± 0,63 (2,0 bis 2,85 ± 0,25 Zoll) und einen distalen gekrümmten Bereich mit einem Krümmungsradius von ungefähr 3,18 bis 5,1 cm ± 0,63 (1,25 bis 2,0 ± 0,25 Zoll) umfassen.
  15. Kardiomyopatie-Koronarsinus-Führungseinführvorrichtung nach Anspruch 1,
    wobei der vorgekrümmte distale Unterbereich (16) ferner drei gekrümmte Bereiche und den gekrümmten oder geraden Bereich, der zum distalen Ende führt, umfasst, wobei die drei gekrümmten Bereiche jeweils einen unterschiedlichen Krümmungsradius aufweisen, wobei der Bereich mit dem größten Krümmungsradius zwischen den anderen zwei gekrümmten Bereichen liegt.
EP03008584A 2002-05-06 2003-04-14 Einführvorrichtung zum Zugriff auf den Koronarsinus des Herzens Expired - Lifetime EP1360972B8 (de)

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US10/139,551 US7462184B2 (en) 2002-05-06 2002-05-06 Introducer for accessing the coronary sinus of a heart

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EP1360972A1 (de) 2003-11-12
ATE442877T1 (de) 2009-10-15
US20030208141A1 (en) 2003-11-06
US7462184B2 (en) 2008-12-09
DE60329254D1 (de) 2009-10-29

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